Once a pericardial effusion has been identified, the critical issue becomes determining whether signs of cardiac tamponade are present - Josh Guttman MD
image by: Niraj Pandya
Pericardial effusion often presents in not-so-obvious ways. We may not immediately think of effusion when we see patients with dyspnea, orthopnea, or chest pain. The “classic” findings of effusion are not so classic in reality. As with many things in EM, we set the tone for patient care, and our consultants or admitting services may anchor on our findings and diagnosis, causing delays when the diagnosis is not correct. It only takes a few seconds to check the heart for an effusion, but it can quickly change the course of a patient's care.
Pericardial effusion often presents in not-so-obvious ways.
Uh oh! A pericardial effusion! Next question, is this tamponade?
The EKG shows the classic findings of a pericardial effusion - electrical alternans. You can see it well in the chest leads V5 & V6. The globus nature of the heart on the CXR should also make you think of pericardial effusion vs a dilated cardiomyopathy. The US is diagnostic - of interest, look at the PSLA and PSSA images closely
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